| Introduction and Overview |
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Welcome to the senior medical student Ambulatory Care Rotation. Internal Medicine has been defined, until this point, by your in-patient experiences on the wards. Outpatient medicine poses different challenges and learning opportunities from in- patient medicine, and we anticipate that you will find it a rewarding experience. This syllabus contains information about the structure of the course, policies and procedures, goals and objectives, schedules, contact information, lecture handouts.
Clinic and lecture schedules will be sent separately. You will receive a course evaluation form at the start of the last lecture of your period. Sue Chadwick (89097) will collect the completed evaluation forms at the end of the lecture. Please complete your evaluation form, as your feedback is vital to the improvement of this course. |
| Course Policies and Procedures |
| Attendance |
- Attendance is mandatory for all of the clinics and lectures. Check your lecture schedules closely! Some lectures start at 8:00 a.m., others at 8:30 or 9:00 a.m. There will be a sign-in sheet at every lecture
- UNEXCUSED ABSENCES. There are no unexcused absences; you may not miss clinics or lectures for any reason.
- EXCUSED ABSENCES. Two excused absences will be allowed. Personal and family crises will be entertained on an individual basis. If emergency circumstances arise, you must call Dr. Raja at 214/648-6354 and Sue Chadwick at 214/ 648-9097 prior to missing a clinic. If the circumstance necessitates missing a clinic, you must also page the attending of the clinic prior to your absence.
- 2 excused absences will require that the course be repeated.
- 3 or more excused absences will result in failure or an incomplete.
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| Lectures |
- Check your lecture schedule carefully for start times and locations as these may vary from week to week.
- Problems with speakers should be brought to Dr. Raja's (86354) attention. If Dr. Raja is not available, notify Sue Chadwick at 89097.
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| General Information |
| Structure of the course: Parkland/VA |
- Each session is a half-day.
- Students attend clinics and lectures Monday through Friday with no duties on the weekends.
- There are seven clinic sessions a week in general medicine and internal medicine subspecialty clinics. This includes one clinic half day spent in a continuity clinic site off campus.
- Students attend two lecture sessions a week on Monday and Thursday mornings and one study session every week to work on a designated project.
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| VAMC |
- Students who are scheduled to attend VA clinics, must page the VA ADPAC computer coordinator at 972-879-1412 at least one week prior to their rotation date to ensure that access codes have been assigned. The Computer Coordinator will meet with the students on their first day of rotation to provide access codes and training on the computer. All charts, x-rays, etc., are paperless and accessed via computer. If a student has not received his/her access codes prior to the start date, access to the patient records will not be available and, therefore, participation on the first day will not be possible.
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| Handouts |
- Pick up handouts for Treemont and PMH Geriatrics clinics on the first day at each site.
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| Grades |
- This is a pass/fail course.
- Students may receive honors for exceptional work.
- Absence from lectures or clinics may result in failure of the course.
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| Course Evaluations |
- Students will be given evaluation forms (clinic and lecture) at the start of the last lecture of their period. Sue Chadwick (89097) will collect the completed evaluation forms at the end of the lecture. Please complete your evaluation form, as your feedback is vital to the improvement of this course.
- Codes for the clinic faculty are listed on pages 5 - 10 in your syllabus.
- If your faculty member does not have a code, please write his/her name on the last page of the code sheet.
- Your feedback is vital to the improvement of this course.
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| Recommended readings/References |
- Guide to Clinical Preventive Services: Report of The U.S. Preventive Services Task Force
- Noble, John Textbook of Primary Care Medicine, 2nd edition. Mosby
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| Course administration and phone numbers |
- Course Director: Hari Raja, M.D.
Phone number: 214/648-6354
Mail Code: 8889
- Administrative Assistant: Sue Chadwick
Phone number: 214/ 648-9097
Mail Code: 9030
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| Course Goals and Objectives |
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By the end of the four-week rotation, students should be able to manage diseases that are treated commonly by internists in the outpatient setting. Since the rotation is limited in time, students should be proficient in the first set of goals and should be exposed to the second set of goals as time and individual student schedules allow. |
| Core curriculum (students should be proficient in these): |
- Evaluation and management of hypertension
- Evaluation and management of the healthy patient
- Evaluation and management of diabetes mellitus
- Evaluation and management of low back pain
- Evaluation and management of joint pain
- Evaluation and management of hyperlipidernia
- Evaluation and management of congestive heart failure
- Evaluation and management of cough
- Evaluation and management of dysuria
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| Additional curriculum (all students will be exposed to these topics in lectures and some of these topics in clinics): |
- Evaluation and management of anemia
- Evaluation and management of fluid and electrolyte and acid base disorders
- Evaluation and management of HIV
- Evaluation and management of substance abuse and tobacco addiction
- Evaluation and management of depression
- Evaluation and management of dyspnea
- Evaluation and management of liver disease
- Evaluation and management of COPD
- Evaluation and management of common cancers
- Evaluation and management of pneumonia
- Evaluation and management of common musculoskeletal complaints
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| Directions for Nutrition Web Cases |
| Jo Ann Carson, Ph.D. |
Within the Ambulatory Care Rotation, students will have an opportunity to gain practical skills for addressing nutrition with patients. One instructional component is a pair of computerized cases. Plan to invest 2-4 hours reviewing the cases, referring to reference information, and responding to the questions on the computer.
You can access the two nutrition cases via Internet or campus server at the UT Southwestern Nutrition Academic Award web site at http://www.utsouthwestern.edu/naa. From that Web Site, click on Student Resources and then on Nutrition Cases. If asked for your user ID, type in your first and last name. If you have any problem accessing the cases contact Jo Ann Carson at the email address listed below; you may also contact Michelle Negri at 648-6280. Remember the cases will likely be faster from a computer on campus.
Go through each case, gathering information as if you were seeing the patients in clinic. You may want to make notes of key information, such as height and weight, abnormal labs, and past meds as you proceed through the case (of course you can go back on the computer to see this information also). If you wish, you can print individual pages of information from the Web, such as the patient's labs, meds, etc. The Resource Section provides you with reference to guidelines, such as NCEP and JNC VI, as well as some general information on nutrients. Some students find it helpful to open two windows with the same site, moving through the series of questions in one window, while keeping the other window at the basic case information (history, physical, labs). The series of questions are not a test, they are an opportunity to team, so feel free to go back and select different answers, allowing you to get more feedback. After you have answered the questions integrated in each case, write the assessment and plan sections of a chart note for each of the patients as you would if you had seen them on their first visit to you in clinic.
Each student should submit his or her own assessment and plan on each of the two patients. You may also include any questions you would like addressed about nutrition issues for these two patients in the class discussion. Cases are due by the 3rd Monday of your Ambulatory Care Rotation, and should be sent to: |
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Jo Ann Carson at Clinical Nutrition Mail Code 8877
OR: JoAnn.Carson@utsouthwestern.edu
OR: deliver to her office at 6011 Harry Hines, Rm. V5.628 |
It will be helpful to bring a copy of the assessment and plans submitted with you to the Nutrition Case Discussion generally scheduled on the 3rd Thursday. If you have questions or problems, you can contact Jo Ann Carson by e-mail or telephone the Department of Clinical Nutrition at (214) 648-1520.
Submission of the clinic notes and completion of an on-line quiz are required for successful completion of the 4th year Family Medicine clerkship. Details of the on-line quiz will be provided to you by email. It is anticipated it will be available for you to take from Thursday of the 3rd week to Tuesday of the 4th week of your rotation. |
